This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, January 30, 2016

Weekly Overseas Health IT Links - 30th January, 2016.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

While the market for inpatient electronic health records is mature, there's still plenty of upside for ambulatory systems as accountable care organizations and patient-centered medical homes struggle to function seamlessly across the continuum of care, according to a new report by Frost & Sullivan.

In its report, U.S. Ambulatory Electronic Health Record Market: 2015–2020, the research firm sees big changes for the outpatient EHR market in the years ahead, as "value-based reimbursement provisions, payer consolidation and EHR optimization agendas" accelerate adoption among ambulatory practices.

Merger and acquisition activity will continue to gain steam as hospitals and large practices snap up smaller practices to bolster bottom lines and grow market share. Meanwhile, on-premise EHR limitations and low returns on investments will often spur practices to move toward cost-effective, cloud-based products that offer remote access and agile IT upgrades, according to the report.

From "script kiddies" to sophisticated nation states, healthcare organizations have to be on the lookout for a variety of dangerous bad actors looking to crack its cybersecurity defenses, according to a recent Institute for Critical Infrastructure Technology report.

The possible impacts from a healthcare security breach are vast. Data from administrative or electronic health record systems can be used to steal the identity of patients and employees, which creates a financial burden and can even lead to legal ramifications.

Furthermore, false information provided by the hacker can also increase the risk of medical complications, according to the report.

The market for medical information is so opaque that many doctors and patients don't realize data from a lab or electronic health record may be anonymized and sold without their consent, according to an article at Scientific American.

It reports growing unease about the expanding use of data mining by commercial entities not just among privacy advocates but among health industry insiders as well.

While longitudinal studies can be beneficial by providing new insights into the long-term effects of drugs and treatments, the under-the-radar market for medical data, the lack of patient consent and the ease at which patients can be identified even from anonymized data raises concerns.

London, ON. – Over 37,000 doctors, nurses, therapists, and other health care professionals across south west Ontario (SWO) are now able to securely access electronic patient information from the region’s 67 hospitals, four Community Care Access Centres (CCACs), four regional cancer programs and provincial clinical systems for laboratory tests and results, and diagnostic imaging via the cSWO Regional Clinical Viewer, ClinicalConnectTM.

For the first time, patient health information from across the continuum of care can be accessed by authorized health care professionals to gather essential patient data in seconds from those organizations using ehealth technology. The implementation of an integrated electronic health record (EHR) has been achieved in south west Ontario – from Windsor to Tobermory to Guelph and through Niagara Falls.

The connecting South West Ontario (cSWO) Program, funded by eHealth Ontario, achieved a major milestone in July of 2015, when the final acute care hospital sites were successfully integrated with the regional clinical viewer. ClinicalConnect is a secure, web-based portal that provides authorized physicians and health care professionals with real-time access to their patients’ EHRs. eHealth Ontario and the cSWO Program, in partnership with Local Health Integration Networks (LHINs) and health service providers in south west Ontario, are enabling health care systems to share patient information across the sector and the province.

Idology, a software vendor enabling providers and insurers to validate the identity of a person not physically present, recently joined the Medical Identity Fraud Alliance, bringing the number of stakeholder and association members to 43 a little more than two years after formation.

John Dancu, CEO at Idology, says he recently became aware of MIFA and wants the company to be part of the collaborative association.

“When you share best practices and fraud trends, it makes the customer stronger,” Dancu notes. Further, making sure a customer is legitimate brings a positive experience to the customer and the healthcare organization, he adds. Idology’s healthcare business has grown quickly in the past three years as the industry awakens to the need for better tools to combat medical identity theft, he says.

The problem with many health apps often comes down to design, creating “a mismatch between what the app is trying to do and what the end users are trying to do,” said Lorraine Chapman, director of healthcare user experience for the global software and design firm Macadamian.

At HIMSS16, Chapman and Jeff Belden, MD, a practicing physician and professor of clinical family and community medicine at the University of Missouri – Columbia, will share five tips for making user-centric design part of your organizational DNA to enable more effective clinical apps.

Barely a month after its launch, the Carequality Interoperability Framework devised by The Sequoia Project has already signed up five health IT heavy-hitters to be the first to implement its data exchange principles: athenahealth, eClinicalWorks, Epic, NextGen Healthcare and Surescripts.

The vendors – at least two of whom have verbally sparred in recent years over their willingness to play ball with interoperability – have agreed to provide health information exchange services for their customers under the Carequality Framework: legal terms, policies, technical specs and processes meant to enable another step forward for nationwide health information exchange.

Primary care providers have mixed views on patient portals, and aren't seeing their vulnerable patients using them much, according to a new study in the Journal of Medical Internet Research.

The researchers, from Wake Forest School of Medicine and elsewhere, conducted in-depth interviews with 20 clinical personnel in four North Carolina counties between October 2013 and June 2014. All of the providers served a lower income population.

They found that the main motivator of implementing a patient portal was external pressure, mainly from the Meaningful Use program, which requires more patient engagement. The providers acknowledged the potential benefits of portals, including:

More Americans are in favor of online access to their medical records, so long as they believed that the site was secure, according to a new study by Pew Research Center.

The study, part of a larger study on privacy and information, surveyed 461 U.S. adults and conducted nine online focus groups of 80 people. It found that 52 percent of respondents were in favor of an online website where they could view their medical records and schedule appointments where the doctor "promises" that it's a secure website. Only 26 percent found that scenario unacceptable.

Patients ages 50 and older were more likely to find such access acceptable than those ages 18 to 49 (62 percent v. 45 percent); those with some college education also were more in favor of such access than those who did not have such education (59 percent v. 44 percent). Those in favor noted that the added convenience and ease would be appealing, although some said that it depended on how secure the website was, who would access the data and whether the respondent in general trusted his or her doctor.

Losing patients due to malicious actors gaining access to systems or hacking medical devices is the top fear for healthcare leaders when it comes to cybersecurity, according to the results of a new survey.

For the survey, conducted by HIMSS on behalf of application security company Veracode, executives also cite damage to their brand, enforcement by government agencies and post-breach costs as major concerns in an environment where breaches are growing in frequency and breadth.

Of more than 200 hospital and health system IT leader participants, 28 percent said their top threat concern is the ability of hackers to take advantage of vulnerabilities in Web- and cloud-based tools such as electronic health record systems and clinical applications.

It might seem strange to compare a patient’s hospital stays to a consumer indulging in the extravagances of a four-star hotels. Yet Yale-New Haven Health System is improving its healthcare services based on real-time patient feedback, collected via tablets, about anything from the cleanliness of rooms to the friendliness of nurses.

Consumers choose hotels based on their reputations for comfort, dining and other amenities. Similarly, patients have several options for healthcare providers, says Lisa Stump, CIO of Yale-New Haven Health System. And in an age where Yelp and Twitter can make or break reputations, hospitals must deliver the best experiences to make patients prefer their facilities. "We give you back some control in an experience where you don't have a lot of control because you're stuck in a hospital bed," Stump says.

Refusing to turn on his webcam, one telemedicine patient insisted on communicating only using the chat box on his provider's mobile app. Eventually, he admitted that he suffered from agoraphobia, germophobia, and social anxiety. This was the only way he felt comfortable seeking care.

Once the realm of science fiction, telemedicine has become a reality of care—and an option for patients that might once have been difficult to reach, including rural patients, professionals with busy schedules, and patients unable or uncomfortable seeking care in person.

Healthcare is the most targeted yet least prepared sector in the U.S. when it comes to cyberattacks, according to a report from the Institute for Critical Infrastructure Technology.

"Both providers and payers devote the majority of their resources to fulfilling their mission," the report's authors say. "Sadly, attackers have seen this selfless dedication to human life as sign of weakness."

Government and healthcare organizations manage complex infrastructure that has many layers that leave gaps, which allows hackers access to sensitive data, according to the authors. What's more, many times, manufacturers no longer support their technology, which creates even more vulnerability. One example of how malicious actors took advantage of this is the Office of Personnel Management hack, which put information of about 4 million federal employees at risk.

Central initiatives, from the plans in the ‘Five Year Forward View’ to clinical commissioning group scorecards, are driving the use of data and analysis in healthcare.

But it is using data to find patients at risk and then to tailor appropriate interventions for them that could really drive change in health and social care, Kim Thomas discovers.

All too often, chronic kidney disease is diagnosed too late – but could there be a way of picking it up earlier?

Using tools from Emis, NHS Camden Clinical Commissioning Group now carries out central searches of GPs’ patient records to identify those patients who might be at risk.

The GPs are informed, and the patient, with their consent, is given a virtual referral to a hospital specialist, who reviews the records and decides on one of three courses of action: that the patient attends the hospital renal clinic, is managed under the care of their GP, or is attended by a community nurse.

Pulse of Longwood takes you inside one of the nation’s largest hubs of hospitals and biomedical research.

Patients with heart failure could soon start beaming their body weight from bathroom scales right to their doctor’s office, as Beth Israel Deaconess Medical Center joins a growing number of hospitals experimenting with mobile technologies to track patients’ health at home.

In doing so, the 672-bed teaching hospital in Boston’s Longwood Medical Area joins the first wave of health care providers using Apple’s HealthKit software to tap into the stream of health information that patients are already collecting on their iPhones.

Since patients are already using smartphones to track how much they step, eat, sleep, and snore, hospitals now want to seize on that data to forge a new type of remote health care that they hope will drive down costs and help people manage chronic diseases.

National Coordinator for Health IT Karen DeSalvo, M.D., applauds the patient identification challenge as an example of private sector leadership with developing national standards and health IT innovation

The College of Healthcare Information Management Executives (CHIME) announced today a National Patient ID Challenge, a $1 million crowdsourcing competition to incentivize the private sector to develop a fail-safe patient identifying solution that links patients to their medical records.

Partnering with HeroX, a crowdsourcing innovation platform, on the initiative, CHIME aims to encourage innovators to help solve the complex problem of patient misidentification There is currently no universal standard to 100 percent accurately identify patients and match them to their medical records. And, since 1999, the federal government is prohibited from spending public funds on the development of a national patient identifier.

The aerial view of the concept of data sharing is beautiful. What could be better than having high-quality information carefully reexamined for the possibility that new nuggets of useful data are lying there, previously unseen? The potential for leveraging existing results for even more benefit pays appropriate increased tribute to the patients who put themselves at risk to generate the data. The moral imperative to honor their collective sacrifice is the trump card that takes this trick.

However, many of us who have actually conducted clinical research, managed clinical studies and data collection and analysis, and curated data sets have concerns about the details. The first concern is that someone not involved in the generation and collection of the data may not understand the choices made in defining the parameters. Special problems arise if data are to be combined from independent studies and considered comparable. How heterogeneous were the study populations? Were the eligibility criteria the same? Can it be assumed that the differences in study populations, data collection and analysis, and treatments, both protocol-specified and unspecified, can be ignored?

Commentary: Thanks to the Affordable Care Act and new care delivery models, provider compensation is increasingly being tied to quality outcomes and cost-effective care. To achieve quality and cost objectives, patient care must be well-coordinated in order to accelerate the delivery of care, reduce wasteful duplicate testing, and minimize the risks and costs associated with missed or delayed diagnosis, medication errors and hospital readmissions.

To effectively and efficiently coordinate care, providers need access to a patient’s complete health record, including details on medications, previous test results and medical history. Initiatives such as the Meaningful Use program and the Direct Project initiative seek to promote the fast and secure exchange of clinical patient information.

However, many organizations have yet to adopt new technologies to facilitate the electronic exchange of health data. In many cases, perceived high implementation costs are to blame. More commonly, the biggest barrier is provider unwillingness to disrupt existing workflows in favor of new processes.

The Food and Drug Administration has issued draft guidance outlining steps medical device manufacturers should take to counter cybersecurity threats.

The agency offers advice on monitoring, identifying and addressing cybersecurity vulnerabilities in medical devices once they have entered the market.

The draft guidance, published Jan. 15, is part of the FDA's effort to ensure the safety and effectiveness of medical devices at all stages in their lifecycle, officials said. They note that in addition to incorporating controls in the design of the device, makers must also consider improvements during maintenance because risks could occur over the device's lifecycle.

Cyber-criminals continue to pose major threats to healthcare information technology departments, and experts say it’s the lure of electronic protected health information that keeps them coming.

“In the last two years, healthcare providers and insurers have been hit by some of the most severe network intrusions ever observed, exposing millions of patient records and costing victim organizations tens of millions of dollars,” said Dan McWhorter, vice president of global threat intelligence and strategy at FireEye, an IT security vendor.

McWhorter will deliver a keynote address at HIMSS16 on the importance of health data security in his presentation, “Emerging Threats: Why is ePHI a Target?”

Healthcare organizations need to not only worry about patient data being compromised by outside sources, but also because of prying eyes within their walls.

Snooping and spying is human nature, Kate Borten, president and founder of The Marblehead Group, tellsHealthITSecurity.com. And as personal health information is increasingly viewed on computer screens, tablets and mobile phones, the ability for someone to see data they shouldn't grows.

A screen facing out into a hallway or waiting area could mean people catching glimpses of very private information, but a solution could be as simple as re-angling the screen, Borten says.

There is growing concern about the impact of health information technology (IT) on patient-clinician communication, yet a study by the American Medical Informatics Association (AMIA) finds that the use of health IT can affect consultations in positive or negative ways depending on a number of factors.

Recent studies have linked high computer use by clinicians with lower patient satisfaction. According to AMIA, the purpose of it study, which was published in the Journal of the American Medical Informatics Association, was to review the current literature on health IT use during the clinical encounter to update best practices and inform the continuous development of health IT policies and educational interventions.

For the study, researchers conducted a literature search of four databases and analyzed about 50 articles and then used a qualitative thematic analysis to compare and contrast the findings across the studies.

On Oct. 6, 2015, CMS and the Office of the National Coordinator for Health IT released the final rules for Stage 3 of the Electronic Health Record Incentive Program and the 2015 Edition Health IT Certification Criteria. Through this rulemaking, the agencies hoped to simplify requirements and add some new flexibilities for providers. They moved from fiscal year to calendar year reporting for all providers beginning in 2015, and they offered a 90-day reporting period for all providers in 2015, for new participants in 2016 and 2017, and for any provider moving to Stage 3 in 2017. They reduced the number of Stage 2 meaningful use objectives from 18 to 10 in 2015-2017, with no change in clinical quality measures. For Stage 3, there will be eight meaningful use objectives (with about 60% of them requiring interoperability).

They also requested additional feedback about Stage 3 of the EHR Incentive Program going forward, in particular with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established the Merit-based Incentive Payment System (MIPS) and consolidated certain aspects of a number of quality measurement and federal incentive programs into one more efficient framework. They plan to use this feedback to inform future policy developments for the EHR Incentive Program, as well as consider it during rulemaking to implement MACRA, which is expected to take place in the spring of 2016.

Scott Mace, for HealthLeaders Media , January 19, 2016

Andy Slavitt throttles back his forecast for the end of meaningful use as we know it, disappointing many, but proving that government reform is coming… at its own excruciating pace.

What are we to make of CMS Acting Administrator Andy Slavitt's pronouncement last week that meaningful use is "effectively over" and that it "will be replaced with something better"?

As of this morning, my take on things is that Slavitt said disappointingly little that was truly new, and various journalists, myself included, jumped to conclusions when we characterized his remarks as a bombshell.

The evidence for this appeared just this morning, as Slavitt himself, in this blog post with Karen DeSalvo, head of the Office of the National Coordinator, basically throttled back his prediction of the end of meaningful use as we know it in 2016.

Respondents to the survey, which polled 236 healthcare leaders from 18 countries, said more than half of their patients wanted faster access to services. 45 percent wanted 24/7 access and connectivity and 42 percent wanted access on more devices. Another 47 percent said they wanted "personalized" experiences.

"Consumers buy across a spectrum of principles," Dave Dimond, chief technology officer of EMC said. Millennials buy on price. The Baby Boomer generation buys on cost and quality, and the builder generation buys based on quality and trust."

But "across the spectrum," he said, "they're interested in convenience."